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GPs to face ban on OTC prescribing for self-limiting illnesses

NHS England will ban GPs from prescribing over-the-counter medicines for 34 self-limiting conditions under proposals to be released in the new year.

Under the new proposals, GPs will be unable to prescribe over-the-counter medicines, including paracetamol, for self-limiting conditions.

NHS England today said it will release a full consultation on restricting OTC prescribing in the new year in a bid to save money, specifically targeting treatments that are cheaper for patients to buy than the NHS.

The 34 conditions include cough and colds, infant colic, mild migraine, malaria prevention and haemorrhoids.

The consultation will also look at the prescribing of probiotics and vitamins and minerals.

At the same time, NHS England released guidance for CCGs on restricting prescribing of 18 medicines that it had previously identified in a consultation earlier this year, which its board approved with few changes.

As a result, NHS England has given CCGs guidance on implementing the changes.

The new consultation is focused on OTC medications that can be purchased by the patient at a lower cost than the NHS pays, treats conditions that are self-limited and could be managed by self care.

As an example, NHS England said: ‘Paracetamol is an average of four times as expensive when provided on prescription by the NHS, compared to when it is purchased in pharmacies or supermarkets. It can costs around £34 for 32 on prescription including dispensing and GP consultation fees.’

It says that it will consider each of the conditions (see box), and decide which treatments should not be routinely offered in primary care.

The NHS England statement says: ‘GPs issued 1.1 billion prescription items at a cost of £9.2 billion in 2015/16. The vast majority were appropriate but many were for medicines, products or treatments that do not require a prescription and can be purchased over the counter from pharmacies, supermarkets, petrol stations, corner shops or other retailers in some cases at a much lower cost than the price paid by the NHS.

‘The NHS could save around £190m a year by cutting such prescriptions for minor, short-term conditions, many of which will cure themselves or cause no long term effect on health.’

The BMA GP Committee’s prescribing lead Dr Andrew Green said: ’The BMA believes it is important for patients to be encouraged to self-care wherever possible, as this is in their own interests as well as those of the wider population. Most GPs already encourage patients to purchase items over-the-counter where appropriate and this will continue. However, where a GP has judged the patient to have a need for a drug, there remains a contractual obligation to offer a prescription which must be honoured.

’We have already expressed our concerns about the impact of these proposals on vulnerable people, and the recognition that there are circumstances where prescribing is appropriate is welcomed, although without legislative change there remains the potential for GPs to be placed in difficult situations. Where this happens GPs must make the care of their patient their first concern.’

Indicative conditions or items for which prescribing could be restricted

1. Probiotics

2. Vitamins and minerals

3. Acute Sore Throat

4. Cold Sores

5. Conjunctivitis

6. Coughs and colds and nasal congestion

7. Cradle Cap (Seborrhoeic dermatitis – infants)

8. Haemorrhoids

9. Infant Colic

10.Contact Dermatitis

11.Dandruff

12.Diarrhoea

13.Dry Eyes/Sore (tired) Eyes

14.Earwax

15.Excessive sweating (Hyperhidrosis)

16.Indigestion and Heartburn

17.Insect bites and stings

18.Malaria prevention

19.Mild Acne

20.Mild Dry Skin/Sunburn

21.Mild to Moderate Hay fever/Allergic Rhinitis

22.Mild Migraine

23.Minor burns and scalds

24.Minor conditions associated with pain, discomfort and/fever. (eg aches and sprains, headache, period pain, back pain)

25.Mouth ulcers

26.Nappy Rash

27.Oral Thrush

28.Prevention of dental caries

29.Ringworm/Athletes foot

30.Scabies/ Head Lice

31.Simple Constipation

32.Teething/Mild toothache

33.Threadworms

34.Travel Sickness

35.Vaginal Thrush

36.Warts and Verrucae

Source: NHS England board paper

Readers' comments (29)

  • ... and if a punter complains? I hope they will also advise the general public of the ban and not put weasel get out clause for themselves!!

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  • All illness is eventually self limiting......

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  • @Atul,

    Our CCG have implemented this type of scheme and saved a lot of money. One of the things they did really well was to provide a route to handle all the complaints - and they certainly backed GPs who tried to stop prescribing etc medications.

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  • Obi - you are missing the point.
    GPs have no wish to become involved with complaints over this - that the complaints will be processed with support for the individual GP is comforting but does not resolve the issue. If HMG or one of its agencies makes such a decision, they should have the common decency to broadcast it to everyone (also much fairer to inform patients what is available).

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  • If they black list them then fine

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  • haha!!! How much does severe malaria cost to treat?
    A strep throat is never acute, is it????
    Oral thrush is never a bother to someone with terminal cancer, is it?
    Head lice never spreads through a school, does it??
    Scabies is such a pleasant condition, isn't it... as is threadworms
    travel sickness... also a very nice way to travel...
    ***Hlth bureaucrats in UK are uncaring disgusting people.

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  • One of the difficulties relates to the use of paracetamol in low-grade but prolonged arthritis. Being able to buy only 32 tablets at any one time, and therefore having to go every few days to the chemist may be possible in the big cities, but in the country it's a nightmare, especially if the nearest chemist is four miles away and you need the medication for three months.

    The other problem is severity. How do you ascertain the severity of pain? At the beginning of my career as a GP I felt that most arthritic pain was minor. Then I had a frozen shoulder/ rotator cuff injury and was on at least one occasion left nearly in tears by the continuous nature of the pain over months. That's quite a different scenario from a short time of the same intensity of pain: it's the unremitting, unrelenting nature of it that makes it a whole new ballgame (especially when you can only buy the tablets in small quantities), so the cost in petrol and time of getting adequate supplies is a considerable overhead.

    The bottom line is that prescribing of paracetamol for chronic or long-time pain needs to be treated separately from acute pain.

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  • NHS ENGLAND WILL "BOTTLE IT" AS USUAL AND SAY IT IS DOWN TO "GP DISCRETION".
    THEN IF WE DON'T PRESCRIBE, WE WILL THEN RECEIVE A LETTER FROM THE GMC SAYING WE ARE "SUBJECT TO INVESTIGATION" FOR REFUSING TO PRESCRIBE VERRUCA OINTMENT ETC-THE USUAL INTIMIDATORY AND MENACING GUFF.

    LOOK, THE JOB IS BAD...NO WORSE...REALLY BAD.
    DON'T LET IT RUIN YOUR LIFE LIKE IT HAS MANY OTHERS....GET OUT, LEAVE, ANYTHING.

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  • When oh when will we start rationing unnecessary investigations in hospital carried out "just in case"? How much does an unnecessary MRI scan cost compared to removal of ear wax? One shows exactly what we already expected clinically, the other allows that deaf old man to hear his family again...

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  • Doctor McDoctor Face

    Most CCGs are trying to stop the prescribing of such meds altogether not just for self limiting illness. 'Self limiting' is just too open ended. Patients are great at learning to game the system and I suspect everyones arthritis will flare up every time they get a snotty nose.

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